RESEARCH AND EDUCATION

Effects of build direction on the mechanical properties of

3D-printed complete coverage interim dental restorations
Nawal Alharbi, BDS, MSc,a Reham Osman, BDS, MSc, PhD,b and Daniel Wismeijer, DDS, PhDc

With recent advances in digital ABSTRACT

technology, the computer Statement of problem. The application of 3-dimensional printing technology is emerging in
aided design and computer dentistry and is being increasingly used to fabricate dental restorations. To date, scientific
aided manufacturing (CAD/ evidence is lacking regarding the effect of different factors on the mechanical properties of the
CAM) of dental restorations is printed restorations with the additive manufacturing technique.
gaining increased popularity.1 Purpose. The purpose of this in vitro study was to evaluate the effect of build direction (layer
CAM fabrication of dental orientation) on the mechanical properties of a novel 3-dimensionally (3D)-printed dental restorative
restorations is possible material.
through either a subtractive or
Material and methods. Based on the printing direction, 2 groups were tested. In the first group
an additive approach. (n=20), the specimens were vertically printed with the layers oriented perpendicular to the load
Subtractive manufacturing direction. In the second group (n=20), the specimens were horizontally printed with the layers
involves 3-dimensional (3D) oriented parallel to the load direction. All specimens were fabricated using the DW028D 3D-printer.
milling of the dental resto- The specimens were loaded with a universal testing machine at a crosshead speed of 1 mm/min
ration from a block of with a 10-kN load cell. The test was performed at room temperature (22 C) under dry testing
material with a computer conditions. The compressive strength was calculated for both groups, and the results were
compared using the unpaired t test (a=.05).
numeric controlled (CNC)
machine. In contrast, additive Results. The mean ±SD compressive strength for the vertically printed specimens was 297 MPa
manufacturing (AM), also (±34) compared with 257 MPa (±41) for the horizontally printed specimens (P=.002).
known as 3D printing or Conclusions. Within the limitations of this study, the layer orientation was found to influence the
rapid prototyping, is used to compressive strength of the material. Vertically printed specimens with the layers oriented
fabricate objects directly from perpendicular to load direction have improved mechanical properties more than horizontally
3D models layer by layer printed specimens with the layers oriented parallel to load direction. (J Prosthet Dent 2016;-:---)
until the object is completed.
The accuracy of milling in the subtractive technology manufacturing, large complex designs can be pro-
depends on the machining tools and the material duced. Furthermore, 3D printing is more economical
properties from which the restoration is fabricated.2 as it does not result in any material waste and unused
Higher material hardness involves lower machin- material can be processed in the future.2 The additive
ability and probably structural defects within the manufacturing technique also enables the printing of
final milled material.2 In contrast, with additive multiple materials at one time.3,4

Supported by scholarship 2/302626 from King Saud University, Riyadh, Kingdom of Saudi Arabia.
a
Doctoral student, Department of Oral Implantology and Prosthetic Dentistry, Academic Centrum for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije
University, Amsterdam, The Netherlands.
b
Researcher, Department of Oral Implantology and Prosthetic Dentistry, Academic Centrum for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University,
Amsterdam, The Netherlands; and Lecturer, Department of Removable Prosthodontics, Faculty of Dentistry, Cairo university, Cairo, Egypt.
c
Professor, Department of Oral Implantology and Prosthetic Dentistry, Academic Centrum for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije
University, Amsterdam, The Netherlands.

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Table 1. Mechanical and physical properties of Temporis material*

Clinical Implications Properties Value
Hardness (Shore D) 92
Application of 3-dimensional (3D) printing Flexural strength (MPa) 93
technology is emerging in the dental field. Build Compressive strength (MPa) 290
direction/orientation are one of the factors that Flexural modulus (MPa) 2700
contribute to the mechanical properties of Ball hardness (MPa) 129
3D-printed restorations. Water absorption (mg/mm3) 22
Water solubility (mg/mm3) <1.2
*Values supplied by manufacturer.

Additive manufacturing techniques used in the dental

field include selective laser sintering (SLS), selective laser
melting (SLM), and stereolithography (SLA).3,4 The selection
of the technique is determined by the material properties,
cost and overall required quality. At present, SLA is the most
commonly used AM technique for dental applications. Sur-
gical guides, dental casts,5-8 maxillofacial prostheses,9
occlusal devices,10 and dental prosthesis substructures11
have all been fabricated by using AM techniques.
In the SLA technique, consecutive layers of photo-
sensitive liquid polymer are polymerized with a focused
ultraviolet light beam until the complete object is
built. SLA offers high accuracy, smooth surface finish,
and fine building details.12 The thickness of the printed
layer, depth and degree of polymerization, shrinkage
between the layers, laser speed, intensity and angle, and
the direction of printing are all factors that influence
the mechanical and physical properties of the printed
material.13
Printing orientation or build direction is one of the
initial and influential steps in the AM techniques. The
time involved in the manufacturing process depends on
the printing orientation. The number of layers used to
fabricate the part varies from one direction to another.
The selected build direction should allow for the least
support area, and so minimal time is needed for finishing
and polishing.14 Shrinkage between the layers is also a
function of the build direction and thus the layer orien-
tation.15 Additionally, the layer orientation influences the
mechanical properties of the printed material that is
anisotropic in nature.13,16 The adhesion between

Figure 1. A, 3D vertically printed cylinder. B, 3D horizontally printed cylinder.

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- 2016 3

Figure 3. DW028D three-dimensional printer (SLA technique). Adapted

from Digital Wax System.

500
Figure 2. A, Illustration of printing direction and layer orientation relative
to load direction of vertically printed cylinder, layer oriented perpen-
0
dicular to load direction. Yellow triangles represent printing support 0 20 40 60 80 100 120 140 160
base. B, Illustration of printing direction and layer orientation relative to
–500
Force (N)

load direction of horizontally printed cylinder, layer oriented parallel to

load direction. Yellow triangles represent printing support-base. –1000

successive layers is weaker than the adhesion within the –1500

same layer. Understanding how the mechanical proper-
ties of the printed materials are affected by different
parameters can help improve the quality and thus the
performance of the fabricated device.13
The purpose of this study was to investigate the effect
of build direction (layer orientation) on the compressive
strength of a novel 3D-printed interim dental restorative
material. The null hypothesis was that the printing di-
rection had no influence on the compressive strength of
the material.
MATERIAL AND METHODS
Forty specimens were 3D-printed in a hybrid composite
resin dental material (Temporis, shade A1, lot: 040725;
DWS) using SLA-AM technology. The material proper-
ties as reported by the manufacturer are shown in
Table 1. The specimens were divided into 2 groups, based
–2000
–2500
Time (s)
Figure 4. Force-time graph of representative tested specimen; load at
failure is marked by black arrow.
on the build direction (layer orientation). In the first
group (n=20), the specimens were printed vertically;
layers were stacked on top of each other along the height
of the sample, perpendicular to the load direction
(Fig. 1A). In the second group (n = 20), the specimens
were printed horizontally; layers were stacked, on top of
each other along the width of the sample, parallel to the
load direction (Fig. 1B). Figure 2 shows the direction of
force application in relation to the build direction and
layer orientation. All specimens were cylindrical in shape,

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Table 2. Mean ±SD of compressive strength
Printing Direction Specimen No. Mean (MPa)
CS Vertical 20 297.7
Horizontal 20 257.7
CS, compressive strength.
*Equal variances not assumed.
Figure 5. A, Horizontal printed specimen before and after test. B, Scanning electron micrograph of deformed horizontally printed specimen (×25
magnification). Barreling effect and separation between layers are observed.
with an average height of 5.04 mm (SD ±0.01) for the
vertically built group and 4.97 mm (SD ±0.02) for the
horizontally built group. The average diameter of cylin-
ders was 3.07 mm (SD ±0.01) for both groups.
All specimens were printed using an SLA 3D-printer
(DW028D; DWS) that used the galvanometer laser
scanning technique (Fig. 3). The printer used a special
laser head, Solid State BluEdge BE-1500. The Laser
scanning speed was 5000 mm/sec, with a layer thickness
of 0.05 mm. All specimens were cleaned with 95%
ethanol and were polymerized after processing with an
ultraviolet polymerization unit (S2; DWS) for 30 minutes.
Before compression testing, all specimens were visu-
ally inspected to ensure that they were free from any
defects or surface roughness. The support material was
removed, and the resultant surface was polished with
ultrathin disks (Soft-Lex; 3M ESPE).
All specimens were tested following the American
Standard Test Method (ASTM) for the compressive
properties of rigid plastics D695-10.17 The test was per-
formed at room temperature (22 C) under dry testing
conditions. All specimens were loaded at a crosshead
speed of 1 mm/min with a universal testing machine
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95% Confidence
Interval of the
Difference*
±SD Mean Difference Lower Upper Cohen d
34.4 40.02 15.7 64.3 1.06
41.1
(Instron 6022; Instron). A load-cell of 10 kN with a
hardened steel flat head was used for the load applica-
tion. Each specimen was uniaxially loaded until the
specimen failed. The failure load was recorded in newton
and was represented by the lowest point of the load
curve produced by the universal testing machine (Fig. 4).
The recorded failure load represents the stress that the
material can withstand before fracture.
The compressive strength was calculated by dividing
F
the force by the surface area using the equation: Cs=p×d 2 .,
4
where Cs is compressive strength at yield (MPa), F is the
force (N), and d is the diameter (mm).18
The deformation pattern of the tested specimens was
examined by using scanning electron microscopy (SEM
XL20; Philips). All the tested specimens were sputter
coated with gold to a thickness of 10 to 15 nm. The scan-
ning was performed under an accelerating voltage of 10 kV.
The results were statistically analyzed with software
(IBM SPSS Statistics for Windows, v21; IBM Corp). The
data were checked for normal distribution and equiva-
lence of variances. The unpaired t test was used to detect
whether a significant difference existed between the 2
groups (a=.05).
Alharbi et al
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Figure 6. A, Scanning electron micrograph of horizontally printed
specimen (×200 magnification) showing layer separation. B, Scanning
electron micrograph of horizontally printed specimen (×2000 magnifi-
cation) showing minor cracks propagating from layer separation.
RESULTS
The mean and standard deviation of the compressive
strength values for both the vertically and horizontally
printed specimens are presented in Table 2. The vertically
printed specimens, where the layer orientation was
perpendicular to load direction, had a significantly higher
compressive strength (297 MPa) than the horizontally
printed (257 MPa) specimens (P=.002). Accordingly, the
null hypothesis that the printing direction has no influ-
ence on the compressive strength of the material was
rejected.
The mode of failure observed was different for each of
the 2 groups. In the horizontally printed specimens,
where the load was applied parallel to the layers, an
overall shortening of the height with an increase in the
width and separation between the printed layers was
Alharbi et al
5
observed (Fig. 5). Several minor cracks propagated from
the main cracks that were created by layer separation
(Fig. 6). However, for the vertically printed specimens,
with the load applied perpendicular to the layer orien-
tation, the layers were compressed toward each other,
resulting in an overall shortening and skewing of the
specimens (Fig. 7).
DISCUSSION
In this in vitro experiment, the effect of layer orientation
on the compressive strength of a recently introduced
printed composite resin restorative material was evalu-
ated. Based on the results, the null hypothesis was
rejected. To the best of the authors’ knowledge, the
current study is the first to evaluate a printed composite
resin material intended for clinical use as an interim
restorative material.
A uniaxial static load was applied to cylinder-shaped
specimens, which does not represent the actual clinical
situation.19 However, as the aim was to investigate the
relationship between the layer orientation and load di-
rection, the selection of uniaxial direction was more
appropriate to provide a basic understanding of various
mechanisms by which the flaws evolve into the material
until its structure fails.20 Moreover, simple structures are
more amenable to simple analysis and prediction.
Several factors can influence the mechanical proper-
ties of material printed with SLA technology, including
build parameters, the postpolymerization process, and
the addition of reinforcing materials to printed resins.13
In the dental field, research continues to improve the
quality of the printed material with the goal of producing
restorative materials suitable for long-term use with good
clinical performance.3
The nature of incremental layers in additive
manufacturing technology may initiate crack propagation
and result in a structural failure of the printed material.
The bonding between the layers is weaker than within
the layer itself. This is explained by the amount of re-
sidual stresses and porosities that accumulate during UV
polymerization and material shrinkage.15
The results show that the horizontally printed speci-
mens with the layers oriented parallel to load direction
had a significantly lower compressive strength than the
specimens printed vertically. In the horizontally printed
specimens, the junction between the layers was in the
path of the load application. Tensile stresses were
generated in the middle portion of the material resulting
in the separation and sliding of the layers on top of each
other. The resultant barreling effect and widening of the
specimens were observed in the SEM images (Fig. 5B).
Consequently, minute propagating cracks originated
from the layer separation and resulted in the observed
structural failure of the material (Fig. 6).
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Figure 7. A, Light photograph of vertically printed specimen before and after test. B, Scanning electron micrograph of deformed vertically printed
specimen (×25 magnification). Skewing effect is observed.

Figure 8. A, Vertically printed specimen before test, red arrow represent applied load. B, Mode of failure in vertically printed specimens; red arrow
represents applied load; light blue line represents layer orientation. Failed specimen shows shortening of original height and skewing effect; light blue
arrow represents shear forces located at layer junction.

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Figure 9. A, Horizontally printed specimens before test; red arrow represents applied load. B, Mode of failure in horizontally printed specimens. Red
arrow represents direction of applied load; light-blue line represents layer orientation. Failed specimen shows shortening of original height and
barreling effect from tensile forces (layer delamination) and shear forces at corners (light blue arrows).

In contrast, the effect of layer separation was minimal
in vertically printed specimens, where the layers were
perpendicular to the load direction. The load applied led
to the compression of the layers on top of each other and
skewing of the cylinder, resulting in the observed overall
shortening and distortion of the specimens (Fig. 7). The
mode of failure is explained in a schematic illustration for
both printing directions in Figures 8 and 9.
The reported compressive strength for the vertically
printed material was high (297 MPa) and comparable
with the average compressive strength values of a well-
established hybrid composite resin restorative material
(289 MPa) with a long-term clinical record.21,22 The
flexural strength reported for the material under inves-
tigation was similar to that reported for artBlock (93 MPa)
and slightly lower than that of TelioCAD (130 MPa)
interim milled restorative materials according to the EM
ISO 10477 standard and as reported by the manufac-
turer.23,24 With an additive manufacturing approach, the
material waste can be reduced to 40% in contrast with
that produced by milling-based technology.25 Addition-
ally, 95% to 98% of the material can be recycled and
reused in the process, thus additive manufacturing may
be considered more sustainable compared with milling
technology.25 Although promising, these results still need
to be further expanded by applying more complex flex-
ural stresses and observing the behavior of the material
before extrapolating the results to the clinical setting.26
Future research should involve testing this printed
material under flexural and tensile stresses with more
anatomically relevant specimens to simulate the oral
environment accurately. The effect of aging on the me-
chanical properties of printed restorative materials should
also be evaluated by using mastication simulators.
Different postpolymerization techniques should be
investigated to select the optimum method. Researching
all of these aspects will ensure a printed restorative
material with a better long-term clinical performance.
CONCLUSIONS
Within the limitation of this in vitro study, layer orien-
tation was found to affect the compressive strength of
the 3D-printed composite material. Material printed

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vertically with the load perpendicular to the layer orien-
tation exhibit a higher compressive strength than mate-
rial printed horizontally.
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Corresponding author:
Dr Nawal Murshed Alharbi
Academic Centre for Dentistry Amsterdam (ACTA)
Department of Oral Implantology and Prosthetic Dentistry
Gustav Mahlerlaan 3004
1081 LA Amsterdam
Netherlands
Email: nawalmurshed@gmail.com
Acknowledgments
The authors thank the following people from Academic Centrum for Dentistry
Amsterdam (ACTA): Mindy Nijo for her technical assistance; and Arie Werner
and Jacqueline Rezende from the Dental Material Science Department. We also
thank Digital Wax System (DWS) for supplying the specimens used in this study.
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Alharbi et al